MEDICARE: FAMILY FIRST PHYSICIANS SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036114320	IL

General Provider Information

NPI Number	:	1437176435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST PHYSICIANS SC

Provider Business Mailing Address
First Line	:	599 PEARSON DR
Second Line	:
City	:	GENOA
State	:	IL
Zip	:	60135-1355
Country	:	US
Telephone Number	:	815-784-6300
Fax Number	:	815-784-6363

Provider Business Practice Location Address
First Line	:	599 PEARSON DR
Second Line	:
City	:	GENOA
State	:	IL
Zip	:	60135-1355
Country	:	US
Telephone Number	:	815-784-6300
Fax Number	:	815-784-6363

Authorized Official
Title or Position	:	OWNER
Name	:	KAREN M FEDERICI
Credential	:	MD
Telephone Number	:	815-784-6300

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	10/14/2009

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Directions to “FAMILY FIRST PHYSICIANS SC ” Practice Location

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